Glenn, you are awesome! I am impressed with your expertise. Yes, the untouched cornea in my eyes are bit more than 300. The doc has disscussed this issue with me. I am not sure if the doc will remove more in the enhancement lasik in the future. 300 sounds pretty thin in comparison with my original 550. Again, thanks a lot!

Remember that 250 is the affirmed minimum and each full diopter requires about 12 microns of tissue. It is not likely that you would need more than 12-18 microns of tissue removal for enhancement surgery, but that bridge you can cross when you arrive.

Today I had the third post-op appointment. A few things happened and I feel uncertain about my eye conditions. Below are the listed issues that upset me.

Issue No.1: the nurse

It took a rather long time for the nurse to use the machine to do the first-step examination before I saw the doctor, and she did many times (more than 5 at least). The nurse was not a newbie, but looked quite nervous then, and the printed results of the exam were destroyed immediately. The machine is just the same kind used by regular eye doctors to issue eyeglass prescriptions. In contrast, during last two post-ops, this procedure was like one-shot thing and results were said not bad.

Apparently, something was going unnormal. After many tries, she finally gave up, asking another seemlingly more expereinced nurse to help. Without saying anything on the results, they both sent me to the doctor's office. The only explanation given to me is that there was something called "alash????" in my eyes and she had to wait until it went away... I didnt understant.

During the appointment, the doctor told me that the physical health of my both eyes are good, and the eye pressure is fine. I asked why it took so much time for the nurse to do a simple examination. The doc's explanation is this: it could be that when eyes are try, vision fluctuates a lot... Anyway, I hope that my eyes are in good conditions and they told me the truth.

Have you ever heard such a situation like mine?

Issue No.2: enhancement

The doctor's response to my question concerning enhancement is this: an introlasik enhancement would be considered again; and a wavefront introlasik would also be an option but depending on my eye conditions in four months.

How much tissue under the flap will be removed? The doc suggested that 10 microns be removed from my right eye, since my right eye vision is still 20/40. I had a chance to had a quick glance over my record: 322 and 327 tissues are left in my eyes. Do you agree on this?

What about the left eye? The doc said my left eye vision is very close to 20/20. It would not require an enhancement. Do you agree on this?

This doctor is only for post-ops, not for lasik surgery. They have clear division of labor.

The nurse's inability to create a test with the device could be due to many issues. I'm not exactly sure which machine to which you refer, but most diagnostic devices require certain conditions that must be met. As an example, the last time I saw my surgeon we were unable to get an accurate wavefront reading because my eyes simply would not naturally dilate. Nothing wrong with the machine or me, but the two just did not see eye-to-eye (pun fully intended).

What is most important at this point is the health of your eyes and your doctor seems to be satisfied there. The removal of 10 microns of tissue would indicate that you are about 0.50 to 0.75 diopters off of target. Your residual corneal tissue is well above the 250 minimum required for stability even with the additional tissue removed.

I concur that you should not consider any additional surgery until 3-6 months postop and you can always wait longer. If I were you I would require an examination and evaluation by the surgeon (not the comanaging doctor) before agreeing to enhancement surgery. That way you get a built-in second opinion.

Their division of labor is for their convenience, not yours. It is certainly reasonable to have one examination by the surgeon before additional surgery.

Otherwise, it sounds like you are experiencing a rather normal recovery, unfortunately you are not exactly on target and may need to consider enhancement surgery.

1, precise data are important. ask the doc exactly how much untouched tissue left in my eyes. The doc will probably discuss enhancment with me at this time. Also, before the enhancement, make sure they use wavefront to examine the thickness of my cornea.

2, remind the surgeon that my not perfect vision after surgery is more likely due to undercorrection than regression. Reason: right eye stays at 20/40. This piece of information may be useful for the doc to decide how quickly my eyes heal and how much regression would occur.

Today I visited the eyecenter where I had my lasik surgery 3 months ago (mid June). The doc concluded that my eyes are healing well. My next post-op exam will be in Nov. I have a question, however; and will greatly appreciate it if someone can offer answers:

Why are the results of the exam not consistent with my personal experience? A month ago my left eye was 20/20-1, and right eye 20/40-1. Now my left eye is 20/40, and right eye 20/40. This is my new prescription:

sph cyl. axis
OD -125 +050 002
OS -150 +075 038

Indeed, I feel that the vision of my both eyes have been reduced over time. Moreover, I feel that my left eye is definitely much better than right eye. For example, when I get up in the early morning, my left eye can read my clock with right eye being covered. But if I cover my left eye to use right eye, I can't see the numbers on the clock.

I asked the doc why my left and right eyes are both 20/40? His explanation is that because my left eye is the dominant eye... He was unwilling to further explain to me...Can you help me with this issue?

Other symptoms:

1, The doc said I have no dry eyes, although I feel my eyes quite dry.

2, My vision fluctuates when I use different parts of my eyeballs to see things. I can see things better from a certain angle than from a different angle. The doc didnt explain this stuff to me.

ericliutexas wrote:1, The doc said I have no dry eyes, although I feel my eyes quite dry.

The feeling of dry eyes may be a phantom due to disruption of the nerves in the cornea that have not healed, or you actually have dry eyes. If the doctor did a tear breakup (TBU) test and a Shrimer test you would know if you have clinically measurable dry eyes. The doctor undoubtedly examined your corneas and did not see evidence of dry eye, but that may be because you are doing a good job of lubricating them with artificial tears.

ericliutexas wrote:2, My vision fluctuates when I use different parts of my eyeballs to see things. I can see things better from a certain angle than from a different angle. The doc didnt explain this stuff to me.

This could be from irregularity in the cornea, most likely your astigmatism.

ericliutexas wrote:3, Poor vision at night/indoor.

That would be expected with over a diopter of residual myopia (nearsighted, shortsighted). If you wear glasses that provide full correction, your night vision should improve dramatically.

ericliutexas wrote:4, the doc said the minimum of untouched corneal should be 300.

Over the years 250 microns has been shown to be the minimum requirement to maintain stability, but more is always better. Many doctors are setting their bottom limit to 300 microns to give the patient an extra margin of safety.

Thank you very much! Here two additional question for you. I will greatly appreciate your answer.

1, my left eye is definitely much better than the right eye. But the doc said that both eyes have same vision 20/40.

For example, when I get up in the early morning, my left eye can read my clock with right eye being covered. But if I cover my left eye to use right eye, I can't see the numbers on the clock.

I asked the doc why my left and right eyes are both 20/40? His explanation is that because my left eye is the dominant eye... He was unwilling to further explain to me...Can you help me with this issue?

A month ago my left eye was 20/20-1, and right eye 20/40-1.

2, This is my new prescription:

sph cyl. axis
OD -125 +050 002
OS -150 +075 038

if an enhancement is needed, how much tissue would be removed? the doc said the enhancement would be customized wavefront.

As a general rule, between 12 and 18 microns of tissue are removed to effect 1.00 diopter of change. If you have enhancement surgery, you would probably have between 14-20 microns of tissue removed.

The Snellen 20/Whatever test measures vision acuity, or quantity, not vision quality. You may be able to recognize familiar black letters on a white background in a controlled environment, but that does not mean that the quality is good. It appears that there is a difference in the quality of vision between your left and right eyes. The doctor could perform a contrast sensitivity test or a wavefront diagnostic to affirm this suspicion.

It's been almost a year since i had my surgery. Although I am gonna have a post-op check next month, I decided yesterday afternoon to go to an independent optical clinic for a comprehensive evaluation.

When I was in the doctor's office, i was really tired so almost fell into sleep....so the vision might not be the best. Below is a brief summary of my eye conditions:

1, over all, very healthy
2, the doctor,however, found my eyes dry, especially my right eye
3, there is regression. Is regression like -2.0 normal?

this is the prescription the independent doctor wrote:

CYLINDER AXIS PRISM
O.D -1.50 -- -- --
O.S -2.00 075 145 --

PD 65/62mm (I dont know what this is)
Corneal angle OD 444 OS /

Tonometry OD 9, OS 8

Meanwhile, I've noticed ghost images, star burst, night vision poor, blurry, etc. Is it good to have an enhancement in summer? I heard winter is better than summer do have an eye sugery. Thanks!